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B.C.’s busiest ER is about to be the biggest (Part 1 of a series)

Surrey Memorial Hospital’s new state-of-the-art emergency department is set to be the second-largest in Canada

Dr. Craig Murray sits proudly inside the new trauma unit at Surrey Memorial Hospital. A special new rail system keeps things off the floor during emergencies.

Photograph by: Mark van Manen
, Vancouver Sun

The dress rehearsals — Day in the Life mock exercises, as they’re called — are almost over. About 100 doctors, nurses and other health professionals at Surrey Memorial Hospital’s new emergency department (ER) are ready to receive their first patients on Oct. 1.

The hospital has the distinction of having B.C.’s busiest ER. Now, at 57,000 square feet, it’s five times bigger. Big enough, in fact, to equal three NHL hockey rinks. Big enough to have the cachet as Canada’s second-largest emergency department (in space and patient volume), after Trillium Health Centre in Mississauga, Ont.

Surrey’s fast exploding population, which has doubled since 1986 and is expected to grow by another 20 per cent in less than a decade, demands a 100-room ER.

It replaces the existing one which was bursting at the seams to accommodate nearly 100,000 patient visits last year. It was built, just two decades ago, for a capacity of less than half of what it has been receiving.

The 1991-built ER will be repurposed as part of the hospital’s half-billion-dollar expansion and redevelopment project. But what it will be turned into is not clear at this point.

Dr. Craig Murray, chief of the ER since 2010, says staff have been doing simulation training exercises during the past few months to get up to speed on the department’s new state-of-the-art features and technology.

“We’ve been running through different scenarios, like massive traumas, to test processes, learn how to use the equipment and to identify any deficiencies,” he said in an interview.

As Murray said that, he was paged on his wireless, hands-free badge device that health professionals will wear on their lapels to communicate with colleagues. Gone are the days when doctors would have to go to a phone to respond to an intercom page.

On a recent, exclusive Vancouver Sun tour of the ER, Murray pointed out some of the features sure to impress patients and their visitors:

• 100 electric stretchers made by Stryker which, among other things, measure the weight of patients.

• White boards in every room so patients and their families can have interactive communication with health care teams. Pediatric patients have wipeable table tops and erasable felt markers kept in baskets at their beds so they can doodle for distraction.

• Televisions in treatment rooms and remote controls designed to be easily disinfected with disposable wipes.

• An all-concrete, six-ambulance holding garage area that can be converted into a disaster command centre.

• A pediatric ER (the second in B.C., after BC Children’s Hospital) with a separate entrance for an anticipated 18,000 to 24,000 patient visits.

• A trauma room with three bays that has the first ceiling boom of its kind in Canada. The boom contains the cables and cords for equipment such as special LED surgery lights that can be readily swung into position for use.

• A decontamination suite for patients exposed to hazardous materials.

• A dozen treatment rooms for patients with infectious diseases. The rooms have their own bathrooms so contagious patients don’t expose others. They also have ante rooms where health care staff can put on their protective masks, gowns and gloves.

• A medical imaging unit close to the trauma area where an anticipated 70,000 tests will be done each year. The CT scanner features a ceiling design of blue sky and blooming cherry trees, in a nod to anxious patients who can now gaze up at something other than dreary walls.

• A dedicated zone for mental health and substance use (MHSU) patients.

With one of every three Surrey residents a juvenile, the separate pediatric zone in the Surrey ER is expected to take pressure off BC Children’s Hospital, not to mention parents and ambulances in the Fraser region who’ve historically had to drive to Vancouver in emergencies.

Although somewhere between 10,000 to 15,000 Fraser region pediatric patients have been treated at BCCH each year, the effect remains to be seen. Maureen O’Donnell, executive director of Child Health BC, said any decreases the BCCH emergency department will experience as a result of the new Surrey pediatric ER will likely be offset by “expected increases to the pediatric population in the province.

“Over the next 15 years, the pediatric population of Vancouver Coastal Health is expected to increase by 13 per cent; Fraser Health is expected to increase 22 per cent; Vancouver Island by 16 per cent and Interior Health by 12 per cent,” she said.

In other words, although the new Surrey pediatric ER will result in a “repatriation” of Fraser patients, an ever-increasing number of children requiring specialized emergency care from across other areas of the province will still have to go to the BCCH emergency department where there were 42,000 patient visits last year.

Through an arrangement between the Vancouver and Surrey hospitals, there has been plenty of professional collaboration, including opportunities for staff exchanges, O’Donnell said.

Hospitals throughout the Fraser region have made little progress in ER decongestion efforts in the past several years as just over half of patients admitted through emergency have been placed in ward beds within 10 hours. (The goal is 80 per cent.) Part of the problem begins at the moment patients enter ERs. Murray said in the new ER, the goal is to completely eliminate delays and lines for registration and triage.

“Patients will arrive, they’ll be quickly assessed and placed in a private treatment room or other appropriate area. The registration will take place at the bedside by staff with mobile equipment,” he said.

Lakh Bagri, acting executive director of SMH, said he couldn’t say how much the ER cost to build since the “construction company (EllisDon) was asked to bid on the whole project so costing one floor was not specifically unidentified.”

The project also includes a new critical care tower (opening in just under a year) and renovations to other hospital areas.

Bagri was also unable to say what the emergency department budget is, or will be.

“Budgets in Fraser Health are broken out by regional programs. Also, many departments provide services to emergency department which are not always broken out. We have been working with each of the service departments to understand and develop operating budgets with them,” he said.

“We do know that there will be an increase (to the Surrey ER expenditures), given the much greater geographical footprint,” he said, referring to the five-times-bigger ER.

Meryl McDowell, director of clinical operations in the mental health and substance use zone of the ER, said Surrey firefighters donated $500,000 to the area, which features private rooms where patients can have consultations with psychiatrists and other mental health professionals, as well as stretcher bays where more patients can be monitored.

In a recent dress rehearsal before ER opening, staff members practised with this scenario: an anxious, depressed patient expressing the motivation to self harm. If such a patient is considered medically stable, and not requiring urgent treatment from ER doctors, he or she would be taken to the MHSU zone. A psychiatric nurse, social worker or other mental health professional would then take over care for the patient.

“The vast majority of patients will be discharged, not admitted, and linked to community resources,” said McDowell, noting that up to 10 per cent (8,000 to 10,000) of all ER patients in Surrey are those with mental health and substance use problems. They often go together, she says.

McDowell says she is proud of the new zone because it takes mental health and substance use patients out of the frenzied atmosphere of the ER.

The separation is not meant to stigmatize them, but rather, to create a calming, low-stimulus, welcoming environment, said Gary Sault, a manager in the MHSU zone.

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